Ready to Go!

October 1st marks an important milestone for transparency in Massachusetts health care. Why?

It is the official start of the all-payer claims database (APCD)!

As you may know from previous blog posts, the APCD will include virtually all health care claims data in Massachusetts. Not only will it support valuable analysis of the health care system, it also will offer consumers and employers a clearer picture and better understanding of the true cost of health care.

So what does “official start” of the APCD mean?

Our regulations require that a subset of health care payers submit private market health care claims data tomorrow to the Division. In addition, the agency was recently approved by the federal government to receive and include Medicare data. Put simply, the Division’s APCD will soon contain approximately 75% of all health care claims data in Massachusetts; an unprecedented achievement as we drive toward transparency, integration, and wellness. In terms of collecting all health care claims in the Commonwealth, our regulations require all payers to submit data from 2008, 2009, and 2010 for medical, dental, and pharmacy claims as well as information about providers, products and member eligibility from the fully-insured and self-insured plans beginning January 2011.

So how did we get here?

Tomorrow's milestone marks the collective efforts and commitment by payers, providers, large and small employers, other government agencies, consumers, policymakers, and researchers – many of whom have representatives serving on an APCD working group. These individuals have been critical to informing our database development and more importantly, to reaching consensus on data elements necessary to analyze trends in health care costs and quality. We will continue to meet with them over the coming months to ensure successful full data submissions in January.

Highlights of the last several months include:

April 2010: The working group assisted in the development of data elements for submission by all health care payers.

May 2010: The Division received overwhelming feedback at the public hearing and comment period from payers, providers, businesses, researchers, policymakers, and sister agencies.

June 2010: The agency held several meetings per week with all payers to discuss technical questions regarding the submission of data and continues to hold monthly technical assistance calls to provide further guidance and clarification. In addition, the Division has worked with sister agencies, including the GIC, DOI, MassHealth, Connector, DPH, and HCQCC, to ensure the APCD will meet their analytic needs which will result in administrative simplification and reduced costs for payers.

July 2010: The final adopted regulations addressed virtually all of the issues raised by the working group including timing of the implementation and data submission, privacy, governance, and confidentiality.

September 2010: Payers began submitting test health care claims files for validation. In addition, the Division received approval from the Centers for Medicare and Medicaid Services (CMS) to integrate Medicare and Medicaid data into the APCD.

What’s next?

In order to continue this successful launch of the APCD, we need all of you to remain engaged in our work and provide your comments and feedback. The APCD’s capacity to inform innovative delivery system redesign and quality improvement initiatives, and to assist individuals in making prudent health care purchasing decisions will require your thoughtful and active participation.

Please don’t hesitate to contact us. We are headed toward full transparency in health care and we want everyone ready to go!

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As a part of our commitment to transparency and engagement in government, the Massachusetts Division of Health Care Finance and Policy uses several social media tools including Twitter, Blogs, and RSS feeds. We use these tools to keep you informed about the work we are doing and as a way to get feedback. You can follow us on Twitter, and you can learn more by visiting the Commonwealth Conversations: Mass Health Care blog.

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One thought on “Ready to Go!”

Well its nice to see that the official start of the all-payer claims database (APCD) & its also good that it offer’s to consumers and employers a clearer picture and better understanding of the true cost of health care, so all n all these sort of things are quite good.